Provider Demographics
NPI:1023995230
Name:MOON, CHRISTOPHER TAEWON (RN, BSN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TAEWON
Last Name:MOON
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N BROADWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1019
Mailing Address - Country:US
Mailing Address - Phone:914-366-1625
Mailing Address - Fax:
Practice Address - Street 1:777 N BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1019
Practice Address - Country:US
Practice Address - Phone:914-366-1625
Practice Address - Fax:914-366-1625
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY707880163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty